- The CAM Act (Lov om alternativ behandling av sykdom mv), section 2, identifies and defines CAM therapies and –treatment as "health-related services which are provided more often outside than inside the official health care system".
- Practising CAM does not require any registration, authorization or license. Neither does it require any medical education nor demonstration of medical competence.
- Medically qualified professionals may provide CAM as long as it is considered in line with the Act regulating Healthcare professionals (Helsepersonelloven); especially the concepts of soundness, properness and professionalism expected in patient care described in section 4 of the act.
What does “health-related treatment” mean?
The terms Alternative/ Health-related treatment obviously cover a wide range of services, modalities and therapies that have in common that they aim to prevent, cure or alleviate illness, ailments and disorders, as well as to strengthen the immune system or the body's self-healing capabilities. Hence, the CAM Act and its definition regulates both treatment of both physical as well as mental health problems. Also, giving dietary and/ or life style advice fall under the definition and Act.
When is a service considered CAM?
In addition to the term that a service must be considered mostly provided outside the official health care system, the other mandatory factor for deciding is if its main intention is mainly health-related, in the meaning that it aims to affect a health problem. Whether research shows efficacy and supports claims of such or not, is not a defining factor.
Payment is generally not a mandatory factor for identifying a service as CAM or not, but strengthens the perception of a patient-provider relationship.
When is a service not considered CAM?
Services that are mainly aimed at and promoted as to increase physical and mental well-being in general, beauty care and the like are not considered CAM - and thus not regulated by the CAM Act.
Also, common religious activities and services that lack clear health ambitions but mainly aim at personal self-development or to improve one’s normal abilities, in principle fall outside the CAM definition and regulation.
Though, the CAM Act may still apply if such services give the impression of improving patient’s state of health in an extended sense (E.g the provision of individual and paid-for religious prayer for improving health problems).
Governmental supervision of CAM
- Medically qualified professionals are always supervised under the Norwegian Supervision Act (Helsetilsynsloven) by the Norwegian Board of Health Supervision (Helsetilsynet) - independent of if they provide conventional medicine or CAM; inside or outside the official health care system.
- CAM treatment provided by non-medically qualified personnel generally falls within the jurisdiction of the Criminal Act (Straffeloven), though the CAM Act itself provides specific penal provisions, especially regarding its sections 5, 6 and 7.
- Though generally focused on supervising medically qualified professionals, the Norwegian Board of Health Supervision (Helsetilsynet) may according to section 9 upon knowledge of and consideration of non-medically qualified CAM provider's practise as hazarduous, request public prosecution.
What is not allowed?
- The CAM Act reserves any treatment aiming to cure serious disease and disorders (E.g cancer, MS, HiV/ AIDS etc); all treatment of serious communicable diseases; plus any medical procedures considered as possibly hazardous to the patient’s health, to only be practised by medically qualified healthcare professionals. Non-medically qualified providers of CAM who break these sections, are subject to punishment.
- In addition, non-medically qualified providers of CAM who break the Act by willfully or through gross negligence placing a person’s life or health in serious danger, may be punished - either because of the treatment itself or because the patient as a result of the treatment omits to seek expert help. Misunderstanding the danger or the nature of the disease does not exempt providers of CAM from responsibility and punishment.
Further regulation and supervision of the CAM field
Complementing the CAM Act, Norway has two national regulations that both relate to the provision of CAM:
- FOR 2003-12-11 nr 1501: Regulation related to marketing of CAM (Forskrift om markedsføring av alternativ behandling av sykdom)
This regulation details CAM providers’ marketing and use of professional titles. It is meant to ensure patient’s safety by keeping marketing of CAM services and providers unbiased and fact-oriented:
- Professional titles in the field of CAM are generally not protected: Anyone may use titles such as "acupuncturist", "herbal therapist" etc.
- Non-medically qualified CAM providers cannot use titles that might confuse them with medically qualified health professionals, or give the impression that they represent the official health care system.
- CAM providers’ marketing of their services cannot give the impression that they are effective for specific health problems.
- CAM providers cannot market treatment directed at patients/ conditions regulated by Sections 5,6 and 7 in the CAM Act.
The marketing and promotion of CAM and non-medically qualified health providers’ use of titles is supervised by the Norway's official Consumer Authority.
- FOR-2003-12-11-1500 Regulation of a voluntary registration system for CAM (Forskrift om frivillig registerordning for utøvere av alternativ behandling)
This regulation details procedures for listing in the voluntary, official ALTBAS Registry, which is meant to improve patient’s safety as well as professionalism among CAM practitioners.
Listing here does not imply official recognition of the provider or his/ her therapies; but ensures patients that the provider has a company listed in the Register of Business Enterprises (Enhetsregisteret); holds a membership in a government-approved practitioner's association with the possibility to make complaints; and holds a valid liability insurance for potential claims for injuries sustained in their CAM practise.
Per 2020, ALTBAS lists about 4.000 providers in total, belonging to some 40 approved providers' associations. The formal approval of CAM providers' associations to the ALTBAS registry is supervised by the Directorate of Health.
If you wish to register in ALTBAS, you must first become a member in an approved association. The different associations' minimum requirements to new members are not standardized and varies greatly.
There is also a number of other, non-approved CAM providers' associations, but holding a membership in one of these do not qualify you for listing in ALTBAS. For an overview of all known CAM providers' associations in Norway, visit this page.
The reimbursement status of CAM practices and CAM products
Expenses for healthcare given from medically qualified professionals are generally reimbursed substantially by the National Insurance Scheme (Folketrygden).
CAM treatment provided by non-medically qualified providers is not reimbursed. Yet private health insurance is not widely used in Norway, some companies offers insurance which reimburse the expense of specific CAM treatments, regardless whether the provider is medically qualified or not.
When CAM is provided by medically qualified health professionals expenses may be reimbursed; if the treatment is considered adequately integrated with conventional treatment and given inside the official healthcare system; such as acupuncture treatment from a midwife for relieving pain during labour inside the hospital; or the use of needles from a physiotherapist as a part of regular physiotherapy treatment.
Expenses for over-the-counter (OTC) health products (such as dietary supplements, homeopathic/ antroposophic remedies and non-prescription plant-based drugs) are not reimbursed. Prescription plant-based drugs are reimbursed on the same level as pharmaceutical drugs. Homeopathic/ anthroposophic remedies are regulated as drugs.
Responsibilities and claims for compensation after injures
The government does not take responsibility for claims for compensation after injuries sustained by CAM treatment from non-medically qualified CAM providers.
If the provider is medically qualified and the CAM treatment is considered adequately integrated into the standard treatment offered by the official health care services, the Act on Patient Injury Compensation (Pasientskadeloven) may apply and such compensation can be granted.
- For example, claims following an injury sustained during acupuncture from a licensed physiotherapist may be covered, if it is considered an integral part of physiotherapy treatment usually given inside the official health care system.
- However, if a medically qualified professional mainly offers CAM treatment outside the official health services, such claims will not be covered. This would be especially true if the status as an medically qualified health professional was used in the promotion of the CAM treatment.
The governmental agency Norwegian System of Patient Injury Compensation (NPE) offers specific assessments about such topics to medically qualified professionals who include or consider to include CAM in their treatment of patients.
Further official engagement in CAM
Along with the passing of the CAM Act and the two regulations, Norwegian health authorities contribute to patient safety via funding solid research and research-based, unbiased public information about CAM. For this purpose, NAFKAM was founded and located inside the Faculty of Health Sciences at UiT the Arctic University of Norway.
In addition to doing research and running web-based information sources, NAFKAM offers a Q&A service to patients, health providers and the media. NAFKAM is also frequently consulted by professional organizations, official bodies and political entities.
For a while, the authorities also gave financial support to the CAM providers' own umbrella association SABORG, aiming to stimulate further professionalism through collaboration, alignment and development across associations. Today, SABORG is supported by ca 1/4 of known CAM providers' associations.
Practising medical healthcare and health-related services (CAM) and in Norway as a foreigner
Persons from abroad who want to practise medical healthcare inside or outside the official health care system as medically qualified professionals, need to be registered and hold a license or authorisation. Further information on this and instructions on how to apply, is found here and the official Altinn Business Information website, under the heading occupational therapist.
Though no registration, medical licence or authorization is needed to offer and practice CAM, one should be aware of the general national rules for starting up and running a business in Norway. Information about this may be found at Altinn. There, it is also provided a help line for those who seek further answers. Information about rules for taxation and VAT can be found at the Norwegian Tax Administration (Skatteetaten).
If you are considering coming to Norway and practising CAM as an employee, ie. in someone else's clinique, you can find useful general information about working in Norway at the official Work in Norway web site.